There is only a little time left to comment on a petition for exemption of the third-class medical requirement for pilots flying recreationally. The exemption petition was submitted to the FAA by the Experimental Aircraft Association and the Aircraft Owners and Pilots Association, and the comment period closes on July 2. As of June 25, there were more than 3,300 comments, but the more comments received, the more the FAA might pay attention.

Why is this important for business aviation?

Actually, this exemption is important for the entire aerospace industry. We’ve seen over and over in countries that don’t support the concept of allowing people to fly freely when they want, wherever they want, that these countries’ aerospace industries are hobbled. Their airliners are flown by expatriate pilots, their airports and airspace are highly restrictive, and what little business aviation they allow is subject to endless delays, onerous permitting requirements and airliner-style treatment. A robust population of recreational pilots is the foundation of a strong aerospace industry. There is no getting around that.

So, if you care about the future of business aviation, about having a source of pilots who want to work their way up to flying with you, mechanics who want to service your aircraft and all the people who work hard to keep our aerospace industry strong, this exemption is important.

To comment on the exemption, go to www.regulations.gov and put Docket No. FAA-2012-0350 in the search box. It takes only a few minutes, and hopefully your voice will be heard.

All that the exemption would do is allow pilots to fly recreationally without having to obtain a third-class medical certificate. According to EAA, “The petition for exemption asks that pilots be able to fly fixed-gear, single-engine airplanes of 180 hp or less carrying no more than one passenger in day VFR using a valid driver’s license as evidence of medical qualification. The exemption also would create an online aeromedical training course that each pilot must study. An online exam will test your retention of the course material.” There are other restrictions, including no night flying, no aircraft with more than four seats, no IFR and no flying in furtherance of a business. Pilots flying to Canada would still have to have at least a third-class medical certificate.

EAA and AOPA believe that the record of the light sport aircraft industry, which doesn’t require pilots to hold an FAA medical certificate, supports this petition. According to EAA, “With the implementation of the Sport Pilot/Light Sport Aircraft Rule, the FAA recognized the driver’s license as a basic form of establishing medical fitness. The use of the driver’s license medical for sport pilots has not negatively impacted safety. There have been no accidents in this community related to medical deficiency.”

The FAA has refused all efforts by EAA and AOPA to eliminate the third-class medical certificate requirement, and those associations feel that this exemption holds promise because it mandates an education component to ensure that pilots keep up to date on medical issues. The prospect of pilots crashing because of medical deficiencies is remote.

This exemption simply makes sense. It would remove an obstacle that keeps many pilots from flying and spending money on aviation and would make available to a reinvigorated pilot population roughly 100,000 airplanes that could be flown recreationally in the U.S.

That is a very good question, and something that is not addressed specifically by the exemption petition. It won’t surprise me if the FAA agrees to the exemption, but reserves the option to disallow recreational flying by pilots who have previously been denied a medical certificate. But, that’s also something that you could include in your comments.

I have a pilot's license and I believe that the elimination of the third class medical for certain pilots would greatly benefit general aviation. I thinks studies show that those catagories of pilots that are not required to have the medical have proven to have a really good safety record. I understand there will be restrictions such as VFR only and no nights flights and it should be.

I am a Vietnam-era Naval Aviator, with 3000 hours in a mix of A-4, A-7, A-6, A-3 and OV-10 aircraft, as well as an additional 2-3 hundred hours on Cessna's single and multi-engine aircraft. I hold Commercial Pilot Airplane Single- and Multi-engine Land Instrument rating. While I am not currently an aircraft owner or pilot, I would like to get back into the air, to shorten the commute time to see my grandchildren in Colorado. Eliminating the requirement for a Class III Medical Certificate would simplify that process. Thanks for your efforts!!

This would be an excellent measure to implement for pilots who fly the lower powered and smaller light planes. These pilots have an excellent safety record and would benefit from
a program where they annually check and monitor there own medical situation. I'm all for this program. Thank you.

This would be an excellent measure to implement for pilots who fly the lower powered and smaller light planes. These pilots have an excellent safety record and would benefit from
a program where they annually check and monitor there own medical situation. I'm all for this program. Thank you.

I have flown since 1970. at the ripe old age of 64, I find it difficult and expensive to go through the process to obtain my third class medical. I fly a Cessna 150 now. I contribute to the local economy through my fuel conspumption, aircraft maintenance, and other aviation related supplies. Unless the above medical exemption is enacted for recreational pilots in the very near future, I will have to hang up my wings. Thank you for your consideration.

Gregory,
Why is it difficult and expensive to maintain a 3rd class medical certificate? When the overall cost of flying is considered, the 3rd class medical certificate is a small portion of that cost. If you have illnesses that require special issuance, the cost of maintaining a medical certificate definitely goes up. I am afraid you are saying that if you didn't need the 3rd class medical certificate you could fly without jumping through the hoops of getting the special issuance, which does not enhance safety. If you have type II diabetes, high blood pressure, coronary artery stents or other common health problems, but don't have timely check-ups that include the items required by the FAA, you are not doing yourself any favors. The AME is your link between your physician and the FAA who can evaluate your treatment and help decide if your illness is under control and the medications are approved by the FAA. I had a call from one of the applicants to whom I provide his 3rd class medical exam who had been prescribed a drug by one of his physicians that is absolutely not allowed by the FAA. Under the situation proposed by EAA and AOPA, it would be possible for a medical condition to deteriorate or a forbidden medication to be prescribed with the pilot continuing to fly. The FAA is trying to streamline the special issuance procedure to help pilots get their medical certificates in a timely manner. The pilot know when his medical certificate expires, and, if he/she has a special issuance, the pilot knows to go see the treating physician(s) to ask for copies of lab work, an appropriate examination, and a letter stating the pilot's current condition before the visit with the AME. At the time of the examination, depending on the illness, the AME can issue the medical certificate providing the information provided is complete and there is nothing that disqualifies the applicant. You should be seeing you physicians, anyway, so why not schedule the visits within 30 days of the expiration of your 3rd class medical certificate? I am afraid there are some pilots who find this to be difficult with a further deterioration of their illness who don't want to quit flying, so they "self-certify" and keep on flying.
Larry W. James, MD
AME, CFI

Dr. James. I take huge exception to your comments. You seem to have the education and ratings to know what you are talking about. It would be too long a letter to list the problems I have with what you say. You make a special issuance sound sensible and easy. It is not. You think pilots will "continue to fly" when they are unfit. On that, you miss the point. Maybe you don't want to lose customers for 3rd class medicals. Maybe you don't trust pilots to self certify because they are not as smart as you. I am glad you are not my doctor. I don't know what your axe to grind is, but I hope the exemption passes in spite of your opinion. If I want to self certify I know I would be happier and safer in a Cessna 150 than in an Aeronca Champ taildragger that I have to hand prop. Just my opinion. There's a lotta Doc's and FAA guys that know a lot more than I do.

Gregory,
Why is it difficult and expensive to maintain a 3rd class medical certificate? When the overall cost of flying is considered, the 3rd class medical certificate is a small portion of that cost. If you have illnesses that require special issuance, the cost of maintaining a medical certificate definitely goes up. I am afraid you are saying that if you didn't need the 3rd class medical certificate you could fly without jumping through the hoops of getting the special issuance, which does not enhance safety. If you have type II diabetes, high blood pressure, coronary artery stents or other common health problems, but don't have timely check-ups that include the items required by the FAA, you are not doing yourself any favors. The AME is your link between your physician and the FAA who can evaluate your treatment and help decide if your illness is under control and the medications are approved by the FAA. I had a call from one of the applicants to whom I provide his 3rd class medical exam who had been prescribed a drug by one of his physicians that is absolutely not allowed by the FAA. Under the situation proposed by EAA and AOPA, it would be possible for a medical condition to deteriorate or a forbidden medication to be prescribed with the pilot continuing to fly. The FAA is trying to streamline the special issuance procedure to help pilots get their medical certificates in a timely manner. The pilot know when his medical certificate expires, and, if he/she has a special issuance, the pilot knows to go see the treating physician(s) to ask for copies of lab work, an appropriate examination, and a letter stating the pilot's current condition before the visit with the AME. At the time of the examination, depending on the illness, the AME can issue the medical certificate providing the information provided is complete and there is nothing that disqualifies the applicant. You should be seeing you physicians, anyway, so why not schedule the visits within 30 days of the expiration of your 3rd class medical certificate? I am afraid there are some pilots who find this to be difficult with a further deterioration of their illness who don't want to quit flying, so they "self-certify" and keep on flying.
Larry W. James, MD
AME, CFI

I am a former airline captain and CFI with nearly 12,000 hours (around 9,000 of airline and 3,000 of GA flying).

The general tone of your comments seems to be that you are concerned that a "relaxation" of the medical requirements for "recreational pilot-type" operations might result in a few pilots "self-certifying" when they really have no business being in the air. You may be absolutely correct, but I still believe the proposed exemption makes great sense. Here's why:

First of all, as you are aware, every pilot is required to assess his fitness to fly prior to and during EVERY flight, regardless of the type of operation, certificate/rating required, and category/class being flown. The proposed exemption would require all pilots using the exemption to take, and pass, additional initial and recurrent training that might greatly assist in making a correct assessment, perhaps improving safety of flight... better informed pilots surely make better decisions overall.

As has already been clearly stated in the supporting documentation for the proposal, the Sport Pilot ranks have had a perfect record - not a single medcial incapacitation incident/accident in the eight years the "self-certification" system has been in use. This evidence clearly shows that the system CAN work well with no decrease in the level of safety.

You are correct that some pilots will try to cheat the system and fly when they know well that they do not meet medical requirements. Realistically, those of us who have been involved with aviation long enough absolutely KNOW that this happens, but I believe most of those cheaters will cheat whether they do so through self-certifying when they know they should not or through flying without a medical when it is required of them. The system isn't perfect now and it never will be.

However, the vast majority of pilots take their responsibilities quite seriously, and those folks will not try to cheat the system. Instead, the new proposal, if approved, may help make many pilots safer through medical education, save hundreds of thousands of dollars in FAA medical exam costs (in southern California the average cost for even a third class medical exam is around $100) that could be spent flying, and help to revitalize our active pilot numbers and the GA industry at a time when we sorely need it.

I think we have nothing to lose and, just perhaps, a great deal to gain through the adoption of this exemption.

I have flown since 1970. at the ripe old age of 64, I find it difficult and expensive to go through the process to obtain my third class medical. I fly a Cessna 150 now. I contribute to the local economy through my fuel conspumption, aircraft maintenance, and other aviation related supplies. Unless the above medical exemption is enacted for recreational pilots in the very near future, I will have to hang up my wings. Thank you for your consideration.

It is clear that the record of the light sport aircraft industry supports this proposal. It is a simple proposal based upon simple and common sense.

I strongly agree with both the EAA and AOPA; the prospect of pilots crashing because of medical deficiencies is remote. This promising proposal is includes and education mandate to ensure that pilots keep up to date on medical issues.

FAA,
I have been a private pilot for 28 years. I really no longer pilot into IMC where my Instrument is needed. I am in excellent in health and really just want to keep flying VFR. Expand the Recreation Pilot requirements so a healthy and strong general aviation industry can continue to support the the backbone of American Transportation.

I am all in favor of the AOPA and EAA plan. I firmly believe that any pilot would not fly if he had a medical condition that would prevent him from flying safely. Glider pilots have been a prime example of this.

If I can drive a car safely, and have no substantive physical or mental issues, there is no reason I shouldn't be allowed to fly within the limits of the proposed medical exemption. I do NOT oppose state drivers license exams, so long as they apply to EVERYONE and have no age limitations. I am age 80, ATP rated with 20,000+ hours, mostly GenAv airtaxi, and enrolled in college, so I think I have a considerable handle on the subject.

As an AME, you have a vested interest. If I can fly a 1320 lb aircraft in VFR, what good reason can you give me that I should not be able to fly a 1420 lb aircraft? The reality is, 30% of your "subjects" are not telling you 100% truth when they come in for their medical, and guess what? They pass. So - what is the point of that? It's called "profit stream." The fact is, nobody but an idiot is going to self-certify if they are medically compromised - and they are the same ones who lie to you when they come to see you. So - the only 'upside' to that is - you get paid. How convenient.

I believe this exemtion would return many airmen to the active group of pilots and further GA. I am an 81 year old and hold commercial certificate but find it too expensive and poor availability of flight Doctors. Still pass drivers test with flying (no pun intended) colots. Still do not need glasses for driving etc. Hope this r regulation goes thru.

Exempt 3rd class medical for recreational pilots
I am membership fo AOPA/EAA, Everyone who drives good records of good health as long years, should gets Pilot License Sportlight, Ultralights and Trikes Flight for one seat than two seats for enjoying recreational pilots so happy for America Freedom for FLYERS. Why FAA hurts Pilots too much? Thanks SMILE...... Marlin

How about the fact that the class III medical is good for at least one year. Regardless of ones health issues, we all better believe that the majority of pilots are treating this topic with the respect it deserves, because it will be a year or more before we have to go do this medical thing again. All the while, the years goes by and nobody has been watching. The FAA knows nothing about my last 12 months and neither does the AME. Until next time or next year, it's just me. For the whole year, most of us self-certify everyday, pilot or not. If something is not right we go get it fixed or we stay home until it is. My blood pressure is up and down along with my blood sugar. My cancer has not come back and it is still too damn hot in the plane during the summer. My cold is so bad I almost got drunk off the cold medicine. But, I don't fly because I have too. I fly because I like too and I don't fly when I feel bad and things are not in check. Look, the FAA and the AME only know about me one day out of the year(s). There is no track record at all of a third class medical keeping the skies safe. It is all of us pilots doing what is right while the FAA is not looking, which is most of the time. Allowing some of the smallest planes in the active fleet to be flown VFR non-business and not at night by self-certifying pilots don't seem to be a big risk. Heck, if nothing else try it for 5 years and see what happens. If things turn bad, but the requirements back on.

I think AOPA is focusing too much attention on changing the recreational rules and not enough or any effort at all in trying to bring about changes to the FAA's attitude when dealing with pilot certification action. There is a need to bring about changes in the way the FAA deals with pilots regarding minor violations. Currently the FAA's action is to Revoke a certificate for even minor violation, even when they, the FAA is wrong. I know that there is pending legislation, to help pilots, but AOPA, as a "PILOT UNION" Needs to do more.

To all of the above commentors that said they support the Class III medical exemption: please make sure you submit your comments to the FAA before July 3. It’s great that you expressed yourself here on AINonline, but it’s vitally important that you also do so on the record with the government at www.regulations.gov (Docket No. FAA-2012-0350).

The cost of a Class III medical shouldn't be the issue. It is the cost of light sport aircraft. This change would cover many more aircraft that are no more complex than the existing fleet of light sport including more tricycle gear planes that are less demanding.

To the AME that made the comment above. I looked up your comment on the FAA web site. You made the comment that you didn’t like four seats aircraft. What is the difference between a C172 and a C150 I say not much I’m a CFI I should know. They are both very forgiving aircraft. I can also say the special issuance is a big hassle and can take you out of the flying loop for two to three months. You say we are not smart enough to self certify are self’s. I know my medication, I know what medication the FAA likes and don’t like, I have research it and talked to my regular doctor about it. This is called being self informed. The medical training that the AOPA is offering will help people to be informed about drugs that are not compatible with flying. Also the LSA data speaks for itself no incapacitations in seven year. Also there has been more accidents because of pilots flying those light sports aircraft that they are unfamiliar with, when they could be flying aircraft that they have more time in. I have been around these LSA’s very bad in any windy condition.

Why exclude night and instrument flying and four seaters or retracts or limit to 180 HP? The pilot is either medically 'safe" or not. Whether the wheels go up or I have two extra empty seats has no bearing on teh medical certificate issue. Why exclude 172 or Mooney or Arrow pilots? What does IMC have to do with anything?

I am a pilot with over 3,000 hours in power and sailplanes, including over 2,500 hours in the Lancair 360 I built. I am an engineer and EAA technical counselor.

Imagine that I and my identical twin are traveling from Denver to San Diego in the next 24 hours. I am flying my 1,015 lb. Lancair. My brother, who lost his FAA medical, is driving his 20,000 lb motor-home.

Imagine that we are both going to suffer massive fatal strokes in the next 24 hours. The probability that I will be flying when I have my stroke is about 1 in 5. The probability that my brother will have his stroke while driving is nearly 100%.

The probability that a small airplane falling randomly out of the sky will kill someone is about 1 in 200, so the probability that my airplane will kill an innocent person in the next 24 hours is 1/4 x 1/200 which equals 1 in 800.

The probability that an out of control motor-home will kill someone is about 1 in 15 due to the high mass and the fact that the concentration of people around roads is orders of magnitude higher than the average concentration of humans in the country.

The probability that my brothers stroke will kill an innocent person is about 1 in 15, over 50 times higher than the probability that my stroke will kill an innocent person.

FAA medical certification forces people out of their airplanes into road vehicles, thereby increasing risk to the public safety, in direct contradiction to the FAA's mandate to protect the public. We can debate what the medical standards for driving should be, but there is no logical argument against the position that medical standards for flying light planes must be lower than for driving, to maximize public safety.

My lightweight two seat Lancair is no more risky as a result of medical incapacitation than a Cessna 172. Limitations based on a constant speed prop and retractable gear make no sense and should be eliminated.

I would have no problem with a requirement that pilots inform their passengers of significant medical conditions so they can make an informed decision about risk. A similar requirement for drivers is also reasonable.

Most, although not all, pilots have enough sense not to fly if they have a health problem. I would suppport the exemption, and I am a former RCAF Flight surgeon. On the other hand I see no good reason to limit the exempthion to 180 HP and fixed gear. There is no good reason that a recreational pilot should be limited to less than 300 HP recip, nor to limit CSU or retract gear. Many of us who fly aircraft of that type fly only recreational. I do see a good reason to limit turbine and turbocharged recip, as these can operate at altitdes for which Recreational pilots have no training. Even professional pilots can get in trouble at those altitudes. Note the death of Payne Stewart, whose professional pilot evidently failed to recognize a decompression at altitude!

How would medical certification prevent the Payne Stewart crash? Why did it not do so?

I agree additional knowledge is needed to fly high or high performance aircraft, but I see no connection to medical certification for light weight aircraft that make a small hole in the ground when they crash, no matter how high they were flying.

I could not disagree more with the attempt to eliminate the third-class medical. All of the alphabet organizations are running around like chickens with their heads cut off, worrying about the shrinking pilot population and how to get more people into aviation. Well, the answer is not by lowering our standards!

Make flying cheaper - fine. But we can't even get GA pilots to stop flying into TFR's. It is an absolute joke to think pilots will comply with the self-certification process that's being proposed. There is no way that "self-certification" is going to be an effective or equivalent level of safety to what we have now.

AIN should be ashamed to be jumping on the bandwagon of GA pilots with health problems who are incapable of, or unwilling to admit they just don't belong in the cockpit of an airplane.

I'm not certain how I feel about your comment. I'm trying to decide if you are either drawing your opinion from first hand experience at subterfuge you may have executed in the past, or if you are not actually a pilot yourself. One thing is clear, you appear have a very low opinion of pilots in general.

My experience is that the overwhelming majority of pilots pride themselves at doing the very best they possibly can. Considering the expense, training, and effort it requires to obtain even a private certificate - never mind a commercial or ATP rating - you already weed out a majority of those who would not take it seriously. Combine this with the statistics pointed out by Bill Hannahan (above), and I believe the risk of any standard being "lowered" or degraded is negligible.

As was pointed out by others here, I personally will not conduct a flight where weather is a concern, airframe acceptability is sub-par, or if I don't feel well or have had medication affect me. To think that I would risk my life or that of others because I'm now empowered to make that decision on my own is what is "ridiculous". Frankly I already make that decision numerous times during the remainder of the year after my AME clears me.

The issue here is really not for the folks who cannot fly, because of a legitimate medical conditions. But rather it is for those who CAN fly but have to spend hundreds of dollars annually to take medical tests (not covered by your medical insurance) just to prove you are safe to fly. It is interesting that even the FAA medical examiner admits that "most" of the Special Issuances are approved. That speaks volumes to the fact that even most people with well controlled, well managed conditions are medically safe to pilot an aircraft.

The keyword here is "medically" safe. If your moral and professional stature is such that you would lie to yourself when considering your wellness and fitness to pilot any given flight... then you have other problems that the Medical Certification was never going to fix or prevent in the first place.

The 3rd class medical has been nothing short of a waste of time and money for all involved. How many AME's have you gone to for a 3rd class medical and it amounts to nothing more than hey, how are you feeling, here you go. Yes, people with obvious medical conditions have probably been denied a medical, but where has it been proven that not having a 3rd class is detrimental to the public? As one writer pointed out, it is many times more dangerous to the general public to be driving a large motor vehicle than it is to be piloting a small aircraft and yet, there is no requirement for them to have a medical. If there was more common sense amongst the FAA and people in general, we wouldn't even be having this discussion.

I'm not certain how I feel about your comment. I'm trying to decide if you are either drawing your opinion from first hand experience at subterfuge you may have executed in the past, or if you are not actually a pilot yourself. One thing is clear, you appear have a very low opinion of pilots in general.

My experience is that the overwhelming majority of pilots pride themselves at doing the very best they possibly can. Considering the expense, training, and effort it requires to obtain even a private certificate - never mind a commercial or ATP rating - you already weed out a majority of those who would not take it seriously. Combine this with the statistics pointed out by Bill Hannahan (above), and I believe the risk of any standard being "lowered" or degraded is negligible.

As was pointed out by others here, I personally will not conduct a flight where weather is a concern, airframe acceptability is sub-par, or if I don't feel well or have had medication affect me. To think that I would risk my life or that of others because I'm now empowered to make that decision on my own is what is "ridiculous". Frankly I already do it the remainder of the year after my AME clears me.

The issue here is really not for the folks who cannot fly, because of a legitimate medical conditions. But rather it is for those who CAN fly but have to spend hundreds of dollars annually to take medical tests (not covered by your medical insurance) just to prove you are safe to fly. It is interesting that even the FAA medical examiner admits that "most" of the Special Issuances are approved. That speaks volumes to the fact that even most people with well controlled, well managed conditions are medically safe to pilot an aircraft.

The keyword here is "medically" safe. If your moral and professional stature is such that you would lie to yourself when considering your wellness and fitness to pilot any given flight... then you have other problems that the medical certification was never going to fix or prevent in the first place.

Dear Sirs and Madam,
I am a pilot and an Interventional Cardiologist and Cardiac Electrophysiologist, dealing with patient's coronary artery disease and arrhythmias. Being a pilot myself, I find it a nuisance to have to obtain a medical every 2 years; however, in the interest of safety to myself and the public, I understand this requirement. I find myself having to see an optometrist to ensure my vision has remained unchanged and my blood pressure, cholesterol, etc... in check just prior to when I need to renew the medical certificate.

I am against exempting the medical requirement for 3rd class. In fact, I am also against exempting light sport aircraft pilots from being required to having a 3rd class. I always hear older pilots saying that they are now going to fly LSA because they know that they now have a failing condition for medical renewal. These pilots should ground themselves rather than starting LSA and claiming ignorance about self-certification for the LSA class if revelation of their medical condition is evident.

The medical certificate is to ensure public safety, passenger safety, and the pilot's safety. I find the FAA to be very forgiving and understanding in providing special issuance. Even if a patient has a coronary stent or pacemaker, he can eventually get an issuance if the physicians and committee find him to be safe. Once granted special issuance for certain conditions, those certain conditions need not be readdressed.

There are physiologic differences when the pilot approaches 4 to 5000 Feet. My Cessna can easily fly to 14000 feet. At this altitude, even if patients have mild pulmonary impairment, the physiology changes can have devastating effects.

The ECG and physical exam give invaluable diagnostic clues to patient's conditions and may unmask silent diseases such as coronary ischemia or cardiomyopathy. A simple history and physical and lung exam can unmask pulmonary diseases.

Therefore, it is in the best interests of the pilots, the passengers, and the public that an annual or biannual visit to the AME be required.

Dear Sirs and Madam,
I am a pilot and an Interventional Cardiologist and Cardiac Electrophysiologist, dealing with patient's coronary artery disease and arrhythmia. Being a pilot myself, I find it a nuisance to have to obtain a medical every 2 years; however, in the interest of safety to myself and the public, I understand this requirement. I find myself having to see an optometrist to ensure my vision has remained unchanged and my blood pressure, cholesterol, etc... in check just prior to when I need to renew the medical certificate.

I am against exempting the medical requirement for 3rd class. In fact, I am also against exempting light sport aircraft pilots from being required to having a 3rd class. I always hear older pilots saying that they are now going to fly LSA because they know that they now have a failing condition for medical renewal. These pilots should ground themselves rather than starting LSA and claiming ignorance about self-certification for the LSA class.

The medical certificate is to ensure public safety, passenger safety, and the pilot. I find the FAA to be very forgiving and understanding in providing special issuance. Even if a patient has a coronary stent or pacemaker, he can eventually get an issuance if the physicians and committee find him to be safe.

There are physiologic differences when the pilot approaches 4 to 5000 Feet. My Cessna can easily fly to 14000 feet. At this altitude, even if patients have mild pulmonary impairment, the physiology changes can have devastating effects.

The ECG and physical exam give invaluable diagnostic clues to patient's conditions and may unmask silent diseases such as coronary ischemia or cardiomyopathy. A simple history and physical and lung exam can unmask pulmonary diseases.

Therefore, it is in the best interests of the pilots, the passengers, and the public that an annual or biannual visit to the AME be required.